<h:html xmlns:h="http://www.w3.org/1999/xhtml" xmlns="http://www.w3.org/2002/xforms" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:jr="http://openrosa.org/javarosa">
  <h:title>TLP Report</h:title>
  <model id="final CHMT">
    <instance xmlns="">
    <root>
	  <Meta>
		<UserID/>
		<DeviceID/>
		<TimeStartRecorded />
		<TimeEndRecorded />
	  </Meta>
      <Date qid="364" gid="61"/>
      <Prov qid="365" gid="61"/>
      <Where qid="366" gid="61"/>
      <Whereother qid="367" gid="61"/>
      <LocWCHC qid="378" gid="61"/>
      <LocWCHCother qid="376" gid="61"/>
      <LocWCSC qid="375" gid="61"/>
      <LocWCSCother qid="377" gid="61"/>
      <LocECHC qid="379" gid="61"/>
      <LocECHCother qid="380" gid="61"/>
      <LocECSC qid="387" gid="61"/>
      <LocECSCother qid="388" gid="61"/>
      <LocGPHC qid="370" gid="61"/>
      <LocGPHCother qid="381" gid="61"/>
      <LocGPSC qid="385" gid="61"/>
      <LocGPSCother qid="389" gid="61"/>
      <LocKZNHC qid="372" gid="61"/>
      <LocKZNHCother qid="383" gid="61"/>
      <LocKZNSC qid="382" gid="61"/>
      <LocKZNSCother qid="384" gid="61"/>
      <LocFSHC qid="371" gid="61"/>
      <LocFSHCother qid="386" gid="61"/>
      <LocFSSC qid="556" gid="61"/>
      <LocFSSCother qid="390" gid="61"/>
      <LocLPSCother qid="391" gid="61"/>
      <LocMPSCother qid="392" gid="61"/>
      <LocNCSCother qid="394" gid="61"/>
      <LocNWSCother qid="393" gid="61"/>
      <Male qid="368" gid="61"/>
      <Female qid="369" gid="61"/>
      <TimeStart qid="374" gid="61"/>
      <TimeEnd qid="373" gid="61"/>
      <AVKit qid="395" gid="62"/>
      <CHMTDVD qid="396" gid="62"/>
      <Chmtscrutinize qid="397" gid="62"/>
      <ChmtSparesBesties qid="398" gid="62"/>
      <ChmtPSA qid="399" gid="62"/>
      <CofacilitateCHMT qid="400" gid="62"/>
      <CofacilitatorCHMT qid="401" gid="62"/>
      <Clinic qid="402" gid="63"/>
      <Clinicother qid="405" gid="63"/>
      <Mindsetuse qid="403" gid="63"/>
      <MindsetTV qid="404" gid="63"/>
      <Grade qid="406" gid="64"/>
      <Print qid="407" gid="64"/>
      <Topics1 qid="409" gid="66"/>
      <Topicother1 qid="410" gid="66"/>
      <Topics2 qid="411" gid="66"/>
      <Topicother2 qid="415" gid="66"/>
      <Topics3 qid="412" gid="66"/>
      <Topicother3 qid="416" gid="66"/>
      <Topics4 qid="413" gid="66"/>
      <Topicother4 qid="417" gid="66"/>
      <Topics5 qid="414" gid="66"/>
      <Topicother5 qid="418" gid="66"/>
      <Support qid="419" gid="67"/>
      <Individual qid="420" gid="67"/>
      <Mon qid="421" gid="68"/>
      <Confirmed qid="408" gid="65"/>
      </root>
    </instance>
	<bind id="hidden1" nodeset="/root/Meta/UserID" type="xsd:string" jr:preload="context" jr:preloadParams="UserID" />
	<bind id="hidden2" nodeset="/root/Meta/DeviceID" type="xsd:string" jr:preload="property" jr:preloadParams="DeviceID" />
	<bind id="hidden3" nodeset="/root/Meta/TimeStartRecorded" type="xsd:dateTime" jr:preload="timestamp" jr:preloadParams="start" />
	<bind id="hidden4" nodeset="/root/Meta/TimeEndRecorded" type="xsd:dateTime" jr:preload="timestamp" jr:preloadParams="end" />
	<bind id="5" nodeset="/root/Date" required="true()" type="xsd:date"/>
    <bind id="6" nodeset="/root/Prov" required="true()" type="xsd:string"/>
    <bind id="7" nodeset="/root/Where" required="true()" type="xsd:string"/>
    <bind id="8" nodeset="/root/Whereother" type="xsd:string" relevant="/root/Where='99'" />
    <bind id="9" nodeset="/root/LocWCHC" type="xsd:string" relevant="/root/Prov='9' and /root/Where='1'"/>
    <bind id="10" nodeset="/root/LocWCHCother" type="xsd:string" relevant="/root/LocWCHC='999'"/>
    <bind id="11" nodeset="/root/LocWCSC" type="xsd:string" relevant="/root/Prov='9' and /root/Where!='1'"/>
    <bind id="12" nodeset="/root/LocWCSCother" type="xsd:string" relevant="/root/Prov='9' and /root/LocWCSC='999'"/>
    <bind id="13" nodeset="/root/LocECHC" type="xsd:string" relevant="/root/Where='1' and /root/Prov='1'"/>
    <bind id="14" nodeset="/root/LocECHCother" type="xsd:string" relevant="/root/LocECHC='999'"/>
    <bind id="15" nodeset="/root/LocECSC" type="xsd:string" relevant="/root/Where!='1' and /root/Prov='1'"/>
    <bind id="16" nodeset="/root/LocECSCother" type="xsd:string" relevant="/root/Prov='1' and /root/LocECSC='999'"/>
    <bind id="17" nodeset="/root/LocGPHC" type="xsd:string" relevant="/root/Prov='2' and /root/Where='1'"/>
    <bind id="18" nodeset="/root/LocGPHCother" type="xsd:string" relevant="/root/LocGPHC='999'"/>
    <bind id="19" nodeset="/root/LocGPSC" type="xsd:string" relevant="/root/Prov='2' and /root/Where!='1'"/>
    <bind id="20" nodeset="/root/LocGPSCother" type="xsd:string" relevant="/root/LocGPSC='999'"/>
    <bind id="21" nodeset="/root/LocKZNHC" type="xsd:string" relevant="/root/Where='1' and /root/Prov='4'"/>
    <bind id="22" nodeset="/root/LocKZNHCother" type="xsd:string" relevant="/root/LocKZNHC='63'"/>
    <bind id="23" nodeset="/root/LocKZNSC" type="xsd:string" relevant="/root/Where!='1' and /root/Prov='4'"/>
    <bind id="24" nodeset="/root/LocKZNSCother" type="xsd:string" relevant="/root/LocKZNSC='999'"/>
    <bind id="25" nodeset="/root/LocFSHC" type="xsd:string" relevant="/root/Where='1' and /root/Prov='3'"/>
    <bind id="26" nodeset="/root/LocFSHCother" type="xsd:string" relevant="/root/LocFSHC='999'"/>
    <bind id="27" nodeset="/root/LocFSSCother" type="xsd:string" relevant="/root/Where!='1' and /root/Prov='3'"/>
    <bind id="28" nodeset="/root/LocLPSCother" type="xsd:string" relevant="/root/Prov='5'"/>
    <bind id="29" nodeset="/root/LocMPSCother" type="xsd:string" relevant="/root/Prov='6'"/>
    <bind id="30" nodeset="/root/LocNCSCother" type="xsd:string" relevant="/root/Prov='8'"/>
    <bind id="31" nodeset="/root/LocNWSCother" type="xsd:string" relevant="/root/Prov='7'"/>
    <bind id="32" nodeset="/root/Male" required="true()" type="xsd:int"/>
    <bind id="33" nodeset="/root/Female" required="true()" type="xsd:int"/>
    <bind id="34" nodeset="/root/TimeStart" required="true()" type="xsd:time"/>
    <bind id="35" nodeset="/root/TimeEnd" required="true()" type="xsd:time"/>
    <bind id="49" nodeset="/root/Topics1" required="true()" type="xsd:string"/>
    <bind id="50" nodeset="/root/Topicother1" type="xsd:string" relevant="/root/Topics1='20'"/>
    <bind id="51" nodeset="/root/Topics2" type="xsd:string"/>
    <bind id="52" nodeset="/root/Topicother2" type="xsd:string" relevant="/root/Topics2='20'"/>
    <bind id="53" nodeset="/root/Topics3" type="xsd:string"/>
    <bind id="54" nodeset="/root/Topicother3" type="xsd:string" relevant="/root/Topics3='20'"/>
    <bind id="55" nodeset="/root/Topics4" type="xsd:string"/>
    <bind id="56" nodeset="/root/Topicother4" type="xsd:string" relevant="/root/Topics4='20'"/>
    <bind id="57" nodeset="/root/Topics5" type="xsd:string"/>
    <bind id="58" nodeset="/root/Topicother5" type="xsd:string" relevant="/root/Topics5='20'"/>
    <bind id="44" nodeset="/root/Support" type="xsd:select1"/>
    <bind id="45" nodeset="/root/Individual" required="true()" type="xsd:select1"/>
    <bind id="36" nodeset="/root/Mon" type="xsd:select1" relevant="/root/MindsetTV='Y'"/>
    <bind id="37" nodeset="/root/AVKit" type="xsd:select1"/>
    <bind id="38" nodeset="/root/CHMTDVD" type="xsd:select1"/>
    <bind id="39" nodeset="/root/Chmtscrutinize" type="xsd:select1"/>
    <bind id="40" nodeset="/root/ChmtSparesBesties" type="xsd:select1"/>
    <bind id="41" nodeset="/root/ChmtPSA" type="xsd:select1"/>
    <bind id="42" nodeset="/root/CofacilitateCHMT" type="xsd:select1"/>
    <bind id="43" nodeset="/root/CofacilitatorCHMT" type="xsd:string" relevant="/root/CofacilitateCHMT='Y'"/>
    <bind id="1" nodeset="/root/Clinic" type="xsd:string" relevant="/root/Where='1'"/>
    <bind id="2" nodeset="/root/Clinicother" type="xsd:string" relevant="/root/Clinic='99'"/>
    <bind id="3" nodeset="/root/Mindsetuse" type="xsd:select1" relevant="/root/Where='1'"/>
    <bind id="4" nodeset="/root/MindsetTV" type="xsd:select1" relevant="/root/Where='1'"/>
    <bind id="46" nodeset="/root/Grade" type="xsd:string" relevant="/root/Where='2' or /root/Where='3'"/>
    <bind id="47" nodeset="/root/Print" type="xsd:select1" relevant="/root/Where='2' or /root/Where='3'"/>
    <bind id="48" nodeset="/root/Confirmed" required="true()" type="xsd:select1"/>
  </model>

  <input bind="5">
    <label>Session Date</label>
    <hint>On what date was the session held?</hint>
  </input>
  <select1 bind="6">
    <label>Province?</label>
    <hint>In which province was the session held?</hint>
    <item>
      <label>Eastern Cape</label>
      <value>1</value>
    </item>
    <item>
      <label>Gauteng</label>
      <value>2</value>
    </item>
    <item>
      <label>Free State</label>
      <value>3</value>
    </item>
    <item>
      <label>Kwazulu Natal</label>
      <value>4</value>
    </item>
    <item>
      <label>Limpopo</label>
      <value>5</value>
    </item>
    <item>
      <label>Mpumalanga</label>
      <value>6</value>
    </item>
    <item>
      <label>North West Province</label>
      <value>7</value>
    </item>
    <item>
      <label>Northern Cape</label>
      <value>8</value>
    </item>
    <item>
      <label>Western Cape</label>
      <value>9</value>
    </item>
  </select1>
  <select1 bind="7">
    <label>Session Location</label>
    <hint>Where was the session held?</hint>
    <item>
      <label>Clinic/hospital</label>
      <value>1</value>
    </item>
    <item>
      <label>Secondary school</label>
      <value>2</value>
    </item>
    <item>
      <label>Primary school</label>
      <value>3</value>
    </item>
    <item>
      <label>Youth Centre</label>
      <value>4</value>
    </item>
    <item>
      <label>Community Centre</label>
      <value>5</value>
    </item>
    <item>
      <label>Church</label>
      <value>6</value>
    </item>
    <item>
      <label>Shopping Centre</label>
      <value>7</value>
    </item>
    <item>
      <label>Taxi Rank</label>
      <value>8</value>
    </item>
    <item>
      <label>Other</label>
      <value>99</value>
    </item>
  </select1>
  <input bind="8">
    <label>Other (specify)</label>
  </input>
  <select1 bind="9"  relevant="/root/Prov='9' and /root/Where='1'">
    <label>Hospital/Clinic WC</label>
    <hint>What is the name of the hospital or clinic in the Western Cape where you had the session?</hint>
    <item>
      <label>2lungile Commnity Health Centre </label>
      <value>1</value>
    </item>
    <item>
      <label>Crossroads Health Centre/Clinic</label>
      <value>2</value>
    </item>
    <item>
      <label>Dunoon clinic</label>
      <value>3</value>
    </item>
    <item>
      <label>GF Jooste Hospital</label>
      <value>4</value>
    </item>
    <item>
      <label>Hermanus Provincial Hospital</label>
      <value>5</value>
    </item>
    <item>
      <label>Khayelitsha Day Hospital</label>
      <value>6</value>
    </item>
    <item>
      <label>Langa Clinic</label>
      <value>7</value>
    </item>
    <item>
      <label>Langa Community Health Centre</label>
      <value>8</value>
    </item>
    <item>
      <label>Nolungile Clinic</label>
      <value>9</value>
    </item>
    <item>
      <label>Nolungile Community Health Centre</label>
      <value>10</value>
    </item>
    <item>
      <label>Other (WC):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="10">
    <label>Other Hospital/Clinic (WC):</label>
    <hint>What is the name of the OTHER hospital or clinic in the Western Cape where you had the session?</hint>
  </input>
  <select1 bind="11" >
    <label>Location WC</label>
    <hint>What is the name of the place in the Western Cape where you had the session?</hint>
    <item>
      <label>Langa High</label>
      <value>1</value>
    </item>
    <item>
      <label>Mfuleni High School</label>
      <value>2</value>
    </item>
    <item>
      <label>Qhayiya Secondary</label>
      <value>3</value>
    </item>
    <item>
      <label>TC Newman Paarl</label>
      <value>4</value>
    </item>
    <item>
      <label>CHMT Office</label>
      <value>5</value>
    </item>
    <item>
      <label>Other (WC):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="12">
    <label>Other Location (WC)</label>
  	<hint>What was the name of this Other Location (WC)?</hint>
    </input>
  <select1 bind="13">
    <label>Hospital/Clinic EC</label>
    <hint>What is the name of the hospital or clinic in the Eastern Cape where you had the session?</hint>
    <item>
      <label>Bisho Hospital</label>
      <value>1</value>
    </item>
    <item>
      <label>Cecelia Makhiwane Hospital</label>
      <value>2</value>
    </item>
    <item>
      <label>Duncan Village Day Hospital</label>
      <value>3</value>
    </item>
    <item>
      <label>East London Day Hospital</label>
      <value>4</value>
    </item>
    <item>
      <label>Frere Hospital</label>
      <value>5</value>
    </item>
    <item>
      <label>Grey Hospital</label>
      <value>6</value>
    </item>
    <item>
      <label>Other (specify)</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="14">
    <label>Other Hospital/Clinic (EC):</label>
    <hint>What is the name of the OTHER hospital or clinic in the Eastern Cape where you had the session?</hint>
  </input>
  <select1 bind="15">
    <label>Location EC</label>
    <hint>What is the name of the place in the Eastern Cape where you had the session?</hint>
    <item>
      <label>David Mama Comprehensive </label>
      <value>1</value>
    </item>
    <item>
      <label>Other (EC):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="16">
    <label>Other Location (EC)</label>
  	<hint>What was the name of this Other Location (EC)?</hint>
  </input>
  <select1 bind="17">
    <label>Hospital/Clinic GP</label>
    <hint>What is the name of the hospital or clinic in Gauteng where you had the session?</hint>
    <item>
      <label>Andries Raditsela Clinic</label>
      <value>1</value>
    </item>
    <item>
      <label>Empilisweni Clinic</label>
      <value>2</value>
    </item>
    <item>
      <label>Joburg General Hospital</label>
      <value>3</value>
    </item>
    <item>
      <label>Kingsway Clinic</label>
      <value>4</value>
    </item>
    <item>
      <label>Mamelodi Day Hospital </label>
      <value>5</value>
    </item>
    <item>
      <label>Nokuthela Ngwenya Community Health Centre</label>
      <value>6</value>
    </item>
    <item>
      <label>Pholosong Hospital</label>
      <value>7</value>
    </item>
    <item>
      <label>Sebei Motoeneng Clinic</label>
      <value>8</value>
    </item>
    <item>
      <label>Sekokeng Hospital</label>
      <value>9</value>
    </item>
    <item>
      <label>Soshanguve Clinic</label>
      <value>10</value>
    </item>
    <item>
      <label>Stanza Bopape</label>
      <value>11</value>
    </item>
    <item>
      <label>Tembisa Health Care Centre</label>
      <value>12</value>
    </item>
    <item>
      <label>Other (Gauteng):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="18">
    <label>Other Hospital/Clinic (GP):</label>
    <hint>What is the name of the OTHER hospital or clinic in Gauteng where you had the session?</hint>
  </input>
  <select1 bind="19">
    <label>Location GP</label>
    <hint>What is the name of the place in Gauteng where you had the session?</hint>
    <item>
      <label>Asser Maloka Secondary</label>
      <value>1</value>
    </item>
    <item>
      <label>Bervely Hills High School</label>
      <value>2</value>
    </item>
    <item>
      <label>Buhlebemfundo Secondary</label>
      <value>3</value>
    </item>
    <item>
      <label>Other (Gauteng):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="20">
    <label>Other Location (GP)</label>
  	<hint>What was the name of this Other Location (GP)?</hint>
  </input>
  <select1 bind="21">
    <label>Hospital/Clinic KZN</label>
    <hint>What is the name of the hospital or clinic in Kwa-Zulu Natal where you had the session?</hint>
    <item>
      <label>Addington Hospital</label>
      <value>41</value>
    </item>
    <item>
      <label>Amanzimtoti Clinic</label>
      <value>42</value>
    </item>
    <item>
      <label>Bevies Hospice</label>
      <value>43</value>
    </item>
    <item>
      <label>Edendale Hospital</label>
      <value>44</value>
    </item>
    <item>
      <label>Gingindlovu Hospital</label>
      <value>45</value>
    </item>
    <item>
      <label>Hope Clinic</label>
      <value>46</value>
    </item>
    <item>
      <label>Inanda Community Clinic</label>
      <value>47</value>
    </item>
    <item>
      <label>Kwa Msane Clinic</label>
      <value>48</value>
    </item>
    <item>
      <label>Mahatma Ghandi Hospital</label>
      <value>49</value>
    </item>
    <item>
      <label>Mtuba Fixed Clinic</label>
      <value>50</value>
    </item>
    <item>
      <label>Nduduzweni Hospice</label>
      <value>51</value>
    </item>
    <item>
      <label>Prince Mshiyeni Hospital</label>
      <value>52</value>
    </item>
    <item>
      <label>RK Khan Hospital</label>
      <value>53</value>
    </item>
    <item>
      <label>St Marys Clinic</label>
      <value>54</value>
    </item>
    <item>
      <label>Ubuntu Bethu Crisis Center</label>
      <value>55</value>
    </item>
    <item>
      <label>Umlazi Clinic</label>
      <value>56</value>
    </item>
    <item>
      <label>Wyebank Clinic</label>
      <value>57</value>
    </item>
    <item>
      <label>Bevies Hospice</label>
      <value>58</value>
    </item>
    <item>
      <label>Other (KZN):</label>
      <value>63</value>
    </item>
  </select1>
  <input bind="22">
    <label>Other Hospital/Clinic (KZN):</label>
    <hint>What is the name of the OTHER hospital or clinic in Kwa-Zulu Natal where you had the session?</hint>
  </input>
  <select1 bind="23">
    <label>Location KZN</label>
    <hint>What is the name of the place in Kwa-Zulu Natal where you had the session?</hint>
    <item>
      <label>Enaleni High School</label>
      <value>1</value>
    </item>
    <item>
      <label>Zwelethu High School</label>
      <value>2</value>
    </item>
    <item>
      <label>Nduduzweni Hospice</label>
      <value>3</value>
    </item>
    <item>
      <label>Ubuntu Bethu Crisis Center</label>
      <value>4</value>
    </item>
    <item>
      <label>Other (KZN):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="24">
    <label>Other Location (KZN):</label>
  </input>
  <select1 bind="25">
  	<label>Hospital/Clinic FS</label>
    <hint>What is the name of the hospital or clinic in the Free State where you had the session?</hint>
    <item>
      <label>Bongani Hospital</label>
      <value>1</value>
    </item>
    <item>
      <label>Matjabeng Clinic</label>
      <value>2</value>
    </item>
    <item>
      <label>Welkom Clinic</label>
      <value>3</value>
    </item>
    <item>
      <label>Other (Free State):</label>
      <value>999</value>
    </item>
  </select1>
  <input bind="26">
    <label>Other Hospital/Clinic (FS):</label>
    <hint>What is the name of the OTHER hospital or clinic in the Free State where you had the session?</hint>
  </input>
  <input bind="27">
    <label>Other Location (FS)</label>
  	<hint>What was the name of this Other Location (FS)?</hint>
  </input>
  <input bind="28">
    <label>Other Location (LP)</label>
  	<hint>What was the name of this Other Location (LP)?</hint>
  </input>
  <input bind="29">
    <label>Other Location (MP)</label>
  	<hint>What was the name of this Other Location (MP)?</hint>
  </input>
  <input bind="30">
    <label>Other Location (NC)</label>
  	<hint>What was the name of this Other Location (NC)?</hint>
  </input>
  <input bind="31">
    <label>Other Location (NW)</label>
  	<hint>What was the name of this Other Location (NW)?</hint>
  </input>
  <input bind="32">
    <label>Males:</label>
    <hint>Number of session participants (male)</hint>
  </input>
  <input bind="33">
    <label>Females:</label>
    <hint>Number of session participants (female)</hint>
  </input>
  <input bind="34">
    <label>Time start:</label>
    <hint>What time did the session start?</hint>
  </input>
  <input bind="35">
    <label>Time end:</label>
    <hint>What time did the session end?</hint>
  </input>
<select1 bind="49">
    <label>#1 Topic</label>
    <hint>What was the #1 topic discussed?</hint>
    <item>
      <label>ARVs and Adherence</label>
      <value>1</value>
    </item>
    <item>
      <label>ARV Readiness</label>
      <value>2</value>
    </item>
    <item>
      <label>Children and HIV </label>
      <value>3</value>
    </item>
    <item>
      <label>HIV and the Immune System </label>
      <value>4</value>
    </item>
    <item>
      <label>Human Rights</label>
      <value>5</value>
    </item>
    <item>
      <label>Nutrition</label>
      <value>6</value>
    </item>
    <item>
      <label>Opportunistic infections  </label>
      <value>7</value>
    </item>
    <item>
      <label>Palliative and Home based care</label>
      <value>8</value>
    </item>
    <item>
      <label>PEP and Rape</label>
      <value>9</value>
    </item>
    <item>
      <label>PMTCT and Maternal Health</label>
      <value>10</value>
    </item>
    <item>
      <label>Positive Living </label>
      <value>11</value>
    </item>
    <item>
      <label>Prevention </label>
      <value>12</value>
    </item>
    <item>
      <label>Safer sex</label>
      <value>13</value>
    </item>
    <item>
      <label>Sexuality</label>
      <value>14</value>
    </item>
    <item>
      <label>STIs</label>
      <value>15</value>
    </item>
    <item>
      <label>Teenage Pregnancy</label>
      <value>16</value>
    </item>
    <item>
      <label>TB</label>
      <value>17</value>
    </item>
    <item>
      <label>VCT </label>
      <value>18</value>
    </item>
    <item>
      <label>Woman&apos;s Health  </label>
      <value>19</value>
    </item>
    <item>
      <label>Other topic</label>
      <value>20</value>
    </item>
  </select1>
  <input bind="50">
    <label>Other</label>
    <hint>Other #1 topic?</hint>
  </input>
  <select1 bind="51">
    <label>#2 Topic</label>
    <hint>What was the #2 topic discussed?</hint>
    <item>
      <label>ARVs and Adherence</label>
      <value>1</value>
    </item>
    <item>
      <label>ARV Readiness</label>
      <value>2</value>
    </item>
    <item>
      <label>Children and HIV </label>
      <value>3</value>
    </item>
    <item>
      <label>HIV and the Immune System </label>
      <value>4</value>
    </item>
    <item>
      <label>Human Rights</label>
      <value>5</value>
    </item>
    <item>
      <label>Nutrition</label>
      <value>6</value>
    </item>
    <item>
      <label>Opportunistic infections  </label>
      <value>7</value>
    </item>
    <item>
      <label>Palliative and Home based care</label>
      <value>8</value>
    </item>
    <item>
      <label>PEP and Rape</label>
      <value>9</value>
    </item>
    <item>
      <label>PMTCT and Maternal Health</label>
      <value>10</value>
    </item>
    <item>
      <label>Positive Living </label>
      <value>11</value>
    </item>
    <item>
      <label>Prevention </label>
      <value>12</value>
    </item>
    <item>
      <label>Safer sex </label>
      <value>13</value>
    </item>
    <item>
      <label>Sexuality</label>
      <value>14</value>
    </item>
    <item>
      <label>STIs</label>
      <value>15</value>
    </item>
    <item>
      <label>Teenage Pregnancy</label>
      <value>16</value>
    </item>
    <item>
      <label>TB</label>
      <value>17</value>
    </item>
    <item>
      <label>VCT </label>
      <value>18</value>
    </item>
    <item>
      <label>Woman&apos;s Health  </label>
      <value>19</value>
    </item>
    <item>
      <label>Other topic</label>
      <value>20</value>
    </item>
  </select1>
  <input bind="52">
    <label>Other</label>
    <hint>Other #2 topic?</hint>
  </input>
  <select1 bind="53">
    <label>#3 Topic</label>
    <hint>What was the #3 topic discussed?</hint>
    <item>
      <label>ARVs and Adherence</label>
      <value>1</value>
    </item>
    <item>
      <label>ARV Readiness</label>
      <value>2</value>
    </item>
    <item>
      <label>Children and HIV </label>
      <value>3</value>
    </item>
    <item>
      <label>HIV and the Immune System </label>
      <value>4</value>
    </item>
    <item>
      <label>Human Rights</label>
      <value>5</value>
    </item>
    <item>
      <label>Nutrition</label>
      <value>6</value>
    </item>
    <item>
      <label>Opportunistic infections  </label>
      <value>7</value>
    </item>
    <item>
      <label>Palliative and Home based care</label>
      <value>8</value>
    </item>
    <item>
      <label>PEP and Rape</label>
      <value>9</value>
    </item>
    <item>
      <label>PMTCT and Maternal Health</label>
      <value>10</value>
    </item>
    <item>
      <label>Positive Living </label>
      <value>11</value>
    </item>
    <item>
      <label>Prevention </label>
      <value>12</value>
    </item>
    <item>
      <label>Safer sex</label>
      <value>13</value>
    </item>
    <item>
      <label>Sexuality</label>
      <value>14</value>
    </item>
    <item>
      <label>STIs</label>
      <value>15</value>
    </item>
    <item>
      <label>Teenage Pregnancy</label>
      <value>16</value>
    </item>
    <item>
      <label>TB</label>
      <value>17</value>
    </item>
    <item>
      <label>VCT </label>
      <value>18</value>
    </item>
    <item>
      <label>Woman&apos;s Health  </label>
      <value>19</value>
    </item>
    <item>
      <label>Other topic</label>
      <value>20</value>
    </item>
  </select1>
  <input bind="54">
    <label>Other</label>
    <hint>Other #3 topic?</hint>
  </input>
  <select1 bind="55">
    <label>#4 Topic</label>
    <hint>What was the #4 topic discussed?</hint>
    <item>
      <label>ARVs and Adherence</label>
      <value>1</value>
    </item>
    <item>
      <label>ARV Readiness</label>
      <value>2</value>
    </item>
    <item>
      <label>Children and HIV </label>
      <value>3</value>
    </item>
    <item>
      <label>HIV and the Immune System </label>
      <value>4</value>
    </item>
    <item>
      <label>Human Rights</label>
      <value>5</value>
    </item>
    <item>
      <label>Nutrition</label>
      <value>6</value>
    </item>
    <item>
      <label>Opportunistic infections  </label>
      <value>7</value>
    </item>
    <item>
      <label>Palliative and Home based care</label>
      <value>8</value>
    </item>
    <item>
      <label>PEP and Rape </label>
      <value>9</value>
    </item>
    <item>
      <label>PMTCT and Maternal Health</label>
      <value>10</value>
    </item>
    <item>
      <label>Positive Living </label>
      <value>11</value>
    </item>
    <item>
      <label>Prevention </label>
      <value>12</value>
    </item>
    <item>
      <label>Safer sex</label>
      <value>13</value>
    </item>
    <item>
      <label>Sexuality</label>
      <value>14</value>
    </item>
    <item>
      <label>STIs</label>
      <value>15</value>
    </item>
    <item>
      <label>Teenage Pregnancy</label>
      <value>16</value>
    </item>
    <item>
      <label>TB</label>
      <value>17</value>
    </item>
    <item>
      <label>VCT </label>
      <value>18</value>
    </item>
    <item>
      <label>Woman&apos;s Health  </label>
      <value>19</value>
    </item>
    <item>
      <label>Other topic</label>
      <value>20</value>
    </item>
  </select1>
  <input bind="56">
    <label>Other</label>
    <hint>Other #4 topic?</hint>
  </input>
  <select1 bind="57">
    <label>#5 Topic</label>
    <hint>What was the #5 topic discussed?</hint>
    <item>
      <label>ARVs and Adherence</label>
      <value>1</value>
    </item>
    <item>
      <label>ARV Readiness</label>
      <value>2</value>
    </item>
    <item>
      <label>Children and HIV </label>
      <value>3</value>
    </item>
    <item>
      <label>HIV and the Immune System </label>
      <value>4</value>
    </item>
    <item>
      <label>Human Rights </label>
      <value>5</value>
    </item>
    <item>
      <label>Nutrition</label>
      <value>6</value>
    </item>
    <item>
      <label>Opportunistic infections  </label>
      <value>7</value>
    </item>
    <item>
      <label>Palliative and Home based care</label>
      <value>8</value>
    </item>
    <item>
      <label>PEP and Rape</label>
      <value>9</value>
    </item>
    <item>
      <label>PMTCT and Maternal Health</label>
      <value>10</value>
    </item>
    <item>
      <label>Positive Living </label>
      <value>11</value>
    </item>
    <item>
      <label>Prevention </label>
      <value>12</value>
    </item>
    <item>
      <label>Safer sex</label>
      <value>13</value>
    </item>
    <item>
      <label>Sexuality</label>
      <value>14</value>
    </item>
    <item>
      <label>STIs</label>
      <value>15</value>
    </item>
    <item>
      <label>Teenage Pregnancy</label>
      <value>16</value>
    </item>
    <item>
      <label>TB</label>
      <value>17</value>
    </item>
    <item>
      <label>VCT </label>
      <value>18</value>
    </item>
    <item>
      <label>Womans Health  </label>
      <value>19</value>
    </item>
    <item>
      <label>Other topic</label>
      <value>20</value>
    </item>
  </select1>
  <input bind="58">
    <label>Other</label>
    <hint>Other #5 topic?</hint>
  </input>
  <select1 bind="44">
    <label>Support group?</label>
    <hint>Was your session with a support group?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="45">
    <label>Individual session?</label>
	<hint>Was your session a one-on-one individual session?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="37">
    <label>CHMT AV Kit?</label>
	<hint>Did you use a CHMT AV Kit?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="38">
    <label>CHMT DVD?</label>
	<hint>Did you show a CHMT DVD?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="39">
    <label>Scrutinize?</label>
	<hint>Did you use Scrutinize material?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="40">
    <label>Spares &amp; Besties DVD?</label>
	<hint>Did you show a Spares and Besties DVD?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="41">
    <label>CHMT PSA?</label>
    <hint>Did you show a CHMT PSA?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="42">
    <label>Co-facilitator?</label>
	<hint>Did someone from CHMT co-facilitate the session with you?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <input bind="43">
    <label>Co-facilitator name(s)?</label>
    <hint>What was the name of the co-facilitator(s)?</hint>
  </input>
  <select1 bind="1">
    <label>Where in hospital/clinic?</label>
    <hint>Where in the hospital / clinic was the session held?</hint>
    <item>
      <label>ARV clinic</label>
      <value>1</value>
    </item>
    <item>
      <label>PMTCT / Antenatal Clinic</label>
      <value>2</value>
    </item>
    <item>
      <label>STI clinic</label>
      <value>3</value>
    </item>
    <item>
      <label>TB clinic</label>
      <value>4</value>
    </item>
    <item>
      <label>General / waiting room</label>
      <value>5</value>
    </item>
    <item>
      <label>Other (specify):</label>
      <value>99</value>
    </item>
  </select1>
  <input bind="2">
    <label>Other(clinic):</label>
  </input>
  <select1 bind="3">
    <label>Mindset DVD?</label>
	<hint>Did you use a Mindset DVD in your session?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="4">
    <label>Mindset TV?</label>
	<hint>Did the session location have a Mindset TV?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="36">
    <label>Mindset equip. on?</label>
	<hint>Was the Mindset equipment on when you arrived?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select bind="46">
    <label>Learners Grade:</label>
    <hint>What grade were the learners?</hint>
    <item>
      <label>Grade 1</label>
      <value>1</value>
    </item>
    <item>
      <label>Grade 2</label>
      <value>2</value>
    </item>
    <item>
      <label>Grade 3</label>
      <value>3</value>
    </item>
    <item>
      <label>Grade 4</label>
      <value>4</value>
    </item>
    <item>
      <label>Grade 5</label>
      <value>5</value>
    </item>
    <item>
      <label>Grade 6</label>
      <value>6</value>
    </item>
    <item>
      <label>Grade 7</label>
      <value>7</value>
    </item>
    <item>
      <label>Grade 8</label>
      <value>8</value>
    </item>
    <item>
      <label>Grade 9</label>
      <value>9</value>
    </item>
    <item>
      <label>Grade 10</label>
      <value>10</value>
    </item>
    <item>
      <label>Grade 11</label>
      <value>11</value>
    </item>
    <item>
      <label>Grade 12</label>
      <value>12</value>
    </item>
  </select>
  <select1 bind="47">
    <label>CHMT print materials used?</label>
	<hint>Did you use CHMT print materials in your session?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
  <select1 bind="48">
    <label>Session Confirmed?</label>
	<hint>Has this session been confirmed with a signature or a stamp?</hint>
    <item>
      <label>Yes</label>
      <value>Y</value>
    </item>
    <item>
      <label>No</label>
      <value>N</value>
    </item>
  </select1>
</h:html>